Studies of the Bladder Defense Mechanism. Ii. Postoperative Cystitis in the Elderly

Abstract

Chronic postoperative cystitis in the elderly patient is a difficult problem, and is especially annoying if all obvious anatomic abnormalities have been corrected. This study of 20 such patients who underwent bladder surgery indicates that several local resistance factors may be related to this continued urinary infection. In elderly postoperative patients with chronic cystitis the bladder defense mechanisms have reached such a state of imbalance that they cannot cope with the invading organisms either by the mechanism of voiding or by vesical‐wall defense factors. The relative importance of the various cellular and serologic local defense mechanisms in resisting bacteria in bladder urine and the bladder mucus layer, mucosa or submucosa is not known. There is no apparent quantitative histologic defect in the local bladder cellular response of the elderly patient. Therefore, a decreased quality of response is implied. In addition, trauma created by indwelling catheterization or by surgery destroys the anatomic integrity of the bladder wall and may thereby encourage the development of deep‐seated infection by permitting tissue invasion. Foci of tissue infestation by E. coli were demonstrated in 1 of 2 patients in whom it was possible to make such a study. These foci are not subject to the normal voiding defense mechanism and the antibacterial factors within the bladder or urine; they can be eliminated only by inflammatory cells, antibodies, or antibacterial agents capable of attaining bactericidal tissue levels. Two axioms were confirmed by this study: 1) any period of preoperative indwelling catheterization should be as brief as possible, and 2) specific antimicrobial therapy should be planned preoperatively so that surgery takes place at a time when the urine and tissues are sterile; this sterility should be maintained until all foreign bodies, such as catheters, are removed from the urinary tract.